Postoperative Radiotherapy for Patients With Resectable Stage III-N2 Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Lei, Tianyu; Li, Jing; Zhong, Hao; Zhang, Huibo; Yan, Jin; Wu, Jie; Li, Lan; Xu, Bin; Song, Qingxu; Hu, Qinyong

doi:10.3389/fonc.2021.680615

Cited by 10 publications

(12 citation statements)

References 54 publications

(53 reference statements)

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“…With a total of 20 studies included, the results indicated that PORT improved OS in completely resected stage N2 NSCLC, and also showed significant improvements in LRFS and DFS. For completely resected stage N2 NSCLC, PORT may yield better survival outcomes, which is consistent with the meta-analysis results of Zhang et al 5 but different from the recent findings of Lei et al 15 We explored the following points to analyze and explain the survival outcomes with advantages.…”

Section: Discussionsupporting

confidence: 66%

Effect of postoperative radiotherapy on survival in patients with completely resected and pathologically confirmed stage N2 non-small-cell lung cancer: a systematic review and meta-analysis

Wang,

Chen,

et al. 2023

Therapeutic Advances in Chronic Disease

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Background: The role of postoperative radiotherapy (PORT) for patients with completely resected stage N2 non-small-cell lung cancer (NSCLC) has been controversial. This study aimed to investigate the efficacy of PORT and prognosis in these patients. Objectives: An updated meta-analysis was conducted in this study to investigate the efficacy of PORT and prognosis in patients with completely resected and pathologically confirmed stage N2 NSCLC. Design: This study is a systematic review and meta-analysis. Data source and methods: Databases were searched up to 2 March 2022. All trials on patients with completely resected and pathologically confirmed stage N2 NSCLC undergoing PORT were screened, and data indicators in the PORT and non-PORT groups were extracted, respectively. The effect of PORT on overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) was estimated. Subgroup and sensitivity analyses were performed. Results: In all, 20 studies involving 6340 patients were finally included. The PORT significantly increased OS [hazard ratio (HR) = 0.77, 95% CI: 0.71–0.84, p < 0.001), LRFS (HR = 0.63, 95% CI: 0.52–0.76, p < 0.001), and DFS (HR = 0.72, 95% CI: 0.63–0.82, p < 0.001) while it showed no significant difference in improving DMFS (HR = 0.86, 95% CI: 0.71–1.05, p = 0.14). Conclusion: Our results suggest that in the postoperative treatment of patients with completely resected and pathologically confirmed stage N2 NSCLC, the addition of PORT provides better local recurrence control and survival benefit, but no benefit for distant metastases. The PORT may be incorporated into the postoperative treatment options for some patients with high-risk factors. However, it needs to be validated by more prospective studies in the future. Trail registration: CRD42022314095.

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Section: Discussionsupporting

confidence: 66%

Effect of postoperative radiotherapy on survival in patients with completely resected and pathologically confirmed stage N2 non-small-cell lung cancer: a systematic review and meta-analysis

Wang,

Chen,

et al. 2023

Therapeutic Advances in Chronic Disease

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“…Our safety findings are relevant to clinical decision‐making for surgically treatable stage III NSCLC because clinical trials have not documented a clear benefit of chemo‐radiation over chemotherapy only for these patients. 26 We found that, before matching, patients treated with chemo‐radiation had larger tumor size and more extensive nodal status, suggesting that providers tend to select chemo‐radiation for patients with more extensive disease. Similarly, even after matching, chemo‐radiation was associated with a greater rate of noncardiac death, suggesting treatment sorting based on unmeasured lung cancer severity.…”

Section: Discussionmentioning

confidence: 78%

“…Chemo‐radiation is recommended for patients who are nonresectable whereas the benefit of chemo‐radiation is less certain for patients who are resectable. 26 …”

Section: Discussionmentioning

confidence: 99%

Cardiac Adverse Events Associated With Chemo‐Radiation Versus Chemotherapy for Resectable Stage III Non‐Small‐Cell Lung Cancer: A Surveillance, Epidemiology and End Results‐Medicare Study

Herbach

O’Rorke

Carnahan

et al. 2022

JAHA

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Background We compared cardiac outcomes for surgery‐eligible patients with stage III non‐small‐cell lung cancer treated adjuvantly or neoadjuvantly with chemotherapy versus chemo‐radiation therapy in the Surveillance, Epidemiology and End Results‐Medicare database. Methods and Results Patients were age 66+, had stage IIIA/B resectable non‐small‐cell lung cancer diagnosed between 2007 and 2015, and received adjuvant or neoadjuvant chemotherapy or chemo‐radiation within 121 days of diagnosis. Patients having chemo‐radiation and chemotherapy only were propensity‐score matched and followed from day 121 to first cardiac outcome, noncardiac death, radiation initiation by patients who received chemotherapy only, fee‐for‐service enrollment interruption, or December 31, 2016. Cause‐specific hazard ratios (HRs) and competing risks subdistribution HRs were estimated. The primary outcome was the first of these severe cardiac events: acute myocardial infarction, other hospitalized ischemic heart disease, hospitalized heart failure, percutaneous coronary intervention/coronary artery bypass graft, cardiac death, or urgent/inpatient care for pericardial disease, conduction abnormality, valve disorder, or ischemic heart disease. With median follow‐up of 13 months, 70 of 682 patients who received chemo‐radiation (10.26%) and 43 of 682 matched patients who received chemotherapy only (6.30%) developed a severe cardiac event ( P =0.008) with median time to first event 5.45 months. Chemo‐radiation increased the rate of severe cardiac events (cause‐specific HR: 1.62 [95% CI, 1.11–2.37] and subdistribution HR: 1.41 [95% CI, 0.97–2.04]). Cancer severity appeared greater among patients who received chemo‐radiation (noncardiac death cause‐specific HR, 2.53 [95% CI, 1.93–3.33] and subdistribution HR, 2.52 [95% CI, 1.90–3.33]). Conclusions Adding radiation therapy to chemotherapy is associated with an increased risk of severe cardiac events among patients with resectable stage III non‐small‐cell lung cancer for whom survival benefit of radiation therapy is unclear.

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“…LNR may also have a considerable role in the use of radiotherapy in the future [33]. The PORT meta-analysis showed no evidence that PORT has obvious benefits [34]. Some studies have even shown that PORT results in a worse prognosis in patients who underwent complete resection for NSCLC [35].…”

Section: Discussionmentioning

confidence: 99%

Lymph node ratio predicts overall survival in patients with stage II non-small cell lung cancer: a population-based SEER analysis

Feng

Zhang

et al. 2022

Discov Onc

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Background In non-small-cell lung cancer (NSCLC), there are many factors that affect prognosis, and the lymph node ratio (LNR) may play a significant role. Our study aimed to confirm the value of the LNR in the prognosis of patients with stage II NSCLC. Methods Patient data were obtained from the Surveillance, Epidemiology and End Results (SEER) database. The classification for the LNR was best determined using the X-tile method. The correlation between the LNR and overall survival (OS) was validated after the Kaplan–Meier analysis was performed. To determine the correlation between the LNR and survival, stratification and the Cox regression analysis were used. Results In our study, 14,183 stage II NSCLC patients were included. Among them, 8303 patients had N1 disease. According to the X-tile analysis, the optimal critical points for the LNR in N1 patients with NSCLC was 0.21 and 0.38. We categorized the cohorts as low (LNR-L ≤ 0.21; n = 5158, 62.1%), medium (0.21 < LNR-M ≤ 0.38; n = 1736, 20.9%), and high (LNR-H > 0.38; n = 1409, 17.0%). According to the Kaplan–Meier analysis, the patients with a high LNR were considerably worse than those with a medium or low LNR (P < 0.001), which was also proven by stratified and multivariate analyses. The value of the LNR was reflected in all the subgroup analyses, especially in patients ages < 60 years. The multivariate competing risks regression analysis revealed that younger age, female sex, T1 disease, adenocarcinoma and N0 disease was associated with a better prognosis after controlling for potential confounders (P < 0.001). Conclusions For patients with stage II NSCLC, the LNR is valuable for assessing prognosis. A higher LNR indicates a worse prognosis.

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Postoperative Radiotherapy for Patients With Resectable Stage III-N2 Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Cited by 10 publications

References 54 publications

Effect of postoperative radiotherapy on survival in patients with completely resected and pathologically confirmed stage N2 non-small-cell lung cancer: a systematic review and meta-analysis

Effect of postoperative radiotherapy on survival in patients with completely resected and pathologically confirmed stage N2 non-small-cell lung cancer: a systematic review and meta-analysis

Cardiac Adverse Events Associated With Chemo‐Radiation Versus Chemotherapy for Resectable Stage III Non‐Small‐Cell Lung Cancer: A Surveillance, Epidemiology and End Results‐Medicare Study

Lymph node ratio predicts overall survival in patients with stage II non-small cell lung cancer: a population-based SEER analysis

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